title: Psychological distress and post-abortion contraceptive method effectiveness level chosen at an urban clinic.
abstract: OBJECTIVE
  We investigated whether more psychological distress before an abortion is associated with the effectiveness of contraception selected (low, moderate, or high effectiveness) at an abortion clinic visit.
  
  
  METHODS
  Using data from 253 women attending an urban abortion clinic that primarily serves low-income women, we tested the association between pre-abortion psychological distress and the effectiveness level of post-abortion contraceptive choice. Based on typical use failure rates, we classified effectiveness of contraceptive choice into three levels-low, moderate, and high effectiveness. We measured psychological distress with four validated measures of depressive, anxious, and stress symptoms, and negative affect, as well as with a global measure comprising these four measures. We used multivariable ordinal logistic regression to measure the association of each psychological distress measure with post-abortion contraceptive method effectiveness level, adjusting for sociodemographic factors, pregnancy history, trimester of abortion, and importance of avoiding pregnancy in the next year.
  
  
  RESULTS
  We found that compared to women experiencing less stress symptoms, negative affect and global psychological distress, women experiencing more stress symptoms [AOR=1.028, 95% CI: 1.001-1.050], negative affect [AOR=1.05, 95% CI: 1.01-1.09] and global psychological distress [AOR=1.46, 95% CI: 1.09-1.95] were more likely to choose more effective versus less effective methods, p<.05, in adjusted models. Using dichotomous psychological measures we found similar results.
  
  
  CONCLUSIONS
  Women experiencing more psychological distress before an abortion selected more effective contraceptive methods after their abortion. Future research should examine whether this distress is associated with subsequent contraceptive use or continuation.
  
  
  CONCLUSIONS
  The current study suggests that contraceptive providers should not assume that women experiencing more psychological distress prefer to use less effective contraceptive methods.
authors.affiliation: Department of Psychiatry, University of California, 3333 California St., Ste. 465, Box 0848, San Francisco, CA 94143-0848, USA. Electronic address: Julia.Steinberg@ucsf.edu.
authors.forename: Julia R
authors.initials: JR
authors.lastname: Steinberg
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Tschann
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
authors.forename: Eleanor A
authors.initials: EA
authors.lastname: Drey
authors.forename: Jody E
authors.initials: JE
authors.lastname: Steinauer
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000328:Adult; D000554:Ambulatory Care Facilities; D002755:Choice Behavior; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior; D005260:Female; D006801:Humans; D011203:Poverty; D011247:Pregnancy; D013315:Stress, Psychological / Q000523:psychology*; D014505:Urban Population; D014930:Women
keywords: Contraceptive effectiveness level; Post-abortion contraceptive method selection; Psychological distress